In Strange Relation, Rachel Hadas, poet, teacher and classicist,
recounts the years just short of a decade of her husband’s descent – retreat is
the word she’d prefer – into dementia. Although no definitive diagnosis emerges
for George’s “spooky condition,” frontotemporal dementia possibly with
Alzheimer’s disease in the frontal lobe seems the most likely. By Hadas’s
reckoning, George’s symptoms began when he was in his late fifties—relatively
young for dementia. Diagnosing any form of early onset dementia is extremely
difficult, especially if memory loss is not among the symptoms, as was the case
with George. Hadas noticed the symptoms — his silences and growing remoteness—
and ascribed them to her husband’s loss of interest in life and their marriage.
She writes, “Slowly and insidiously your partner changes from the person you
married into someone else.”

The book opens in 2004, just before his diagnosis in 2005 at the
age of 61. George Edwards was a successful and celebrated composer of
symphonies, chamber works and art songs, as well as a professor of music at
Columbia University. Through flash-backs, Hadas fills in a portrait of a happy,
mutually supportive marriage of two engaged, successful artists, a life that
slowly melted away as George’s disease tightened its grip. She ends with George
in a long-term care residence in 2009, the year Strange Relation was published
and two years before his death in 2011.

The core of the book, intertwined with the story of George’s
dementia, is Hadas’s account of the comfort she sought and gained from reading
and writing prose and poetry. “This ordeal has eloquently reminded me of the
sustaining power of literature,” she writes. “These gifts of the imagination,”
gave her strength. “They are not sufficient, but they are damn well
necessary.”

Over seven decades of reading have given Hadas a vast store of
literary references to draw on. George is Mr. Dick from David Copperfield,
mentally scattered, shuffling his papers; he is King Lear, losing clarity and
dignity and consumed with anger and humiliation as he feels his abilities fade.
Like Penelope awaiting Ulysses’ return, Hadas sees herself living with George
as “neither wife nor widow,” her husband a physical presence but spiritually
gone. When she reads James Merrill’s “Days of 1964,” she identifies with the
poet who “has gone so long without loving that I hardly knew what I was
thinking.” The poem speaks to her as it captures, “The thirst, the loneliness,
the habituation to emotional deprivation that marked the way I was living.”

A recurrent theme that many will relate to is the loneliness she
feels caring for someone who, because of his condition, hardly speaks or
expresses emotion. Robert Frost’s “Home Burial” reminds her how quickly friends
will turn away from death and illness and “make their way back to life.”
Sickness, says Flannery O’Connor, is a country “where there’s no company, where
no one can follow.” She sees her life reflected in Philip Larkin’s wry poem
about a couple’s estrangement, “Talking in Bed,” – the couple’s growing
estrangement is “this unique distance from isolation.” Hadas finds the clarity
and the company of these works a huge comfort.

There are moments of uplift, too. When her college-age son,
Jonathan, and his friends propose to take George on a two-week getaway of very
rustic living in Vermont, she reluctantly agrees, certain that disaster or
injury will ensue. The reader is as relieved as Hadas is when all goes off
without a hitch.

A recurrent theme of the book is the importance of the language
used to describe a disease and its treatment. Metaphors and similes, of course,
are staples of medical caregiving – “they help us see freshly,” says Hadas;
they help her step outside the moment and understand George, whom she describes
as retreating into a “walled garden” or behind a “frosted window”; his disease
is a bath in which he’s immersed and can never escape; it is a malignant fluid
his brain is stewing in.

Equally, using the wrong metaphors and similes can cause pain and
guilt. A neurologist tells Hadas that she’s feeling depressed because Hadas has
moved into a “new house” and is still living out of boxes, still in transition.
“Make yourself at home,” the doctor advises, “I don’t think you’ve completely
moved in yet.” This only makes Hadas feel inadequate and guilty. “Let’s at
least find the right kind of house,” she writes. Caring for a person with
dementia, as she sees it, is not a house but a prison in which the family
caregiver is the voluntary inmate, “responsible for the daily care of a warden
who has mysteriously changed into a ward.”

By the end of the memoir, George has declined to the point that
Hadas can no longer care for him and has found him a residence, which raises a
new host of concerns. He fails out of the first home and she finds
another. She visits George regularly and experiences a new kind of tethered
freedom. Her divided self, composed of the Drudge and the Poet, dusts off their
apartment to reclaim it from the associations of George’s illness, hoping to
rescue her memories of twenty years of happiness before his illness began to
take him. “It became my home in a new and different way.”

Each phase of her journey is accompanied by poems, twenty-nine in
all, that Hadas wrote to understand herself, clarify her feelings, cope with
the loss of George. Never was Robert Frost’s dictum regarding the ingredient of
a successful poem— “No surprise for the writer, no surprise for the reader”
—more pertinent. Along with her reading, Hadas’s poems lead her to insights
that comforted and sometimes surprised her—and will do the same for the
reader.

The book ends with George’s birthday party in 2009 at the
long-term care residence where he finally settled. He died shortly after the
book was published in 2011.

Maggie O’Farrell describes the book in a scene involving a casual conversation she has with her mother over tea.

As she lifts the pot to the table, she asks me what I’m working on at the moment, and, as I swallow my water, I tell her I’m trying to write a life, told only through near death experiences. She is silent for a moment, readjusting cosy, milk jug, cup handles. ‘Is it your life?’ she asks. ‘Yes,’ I say, a touch nervously. I have no idea how she’ll feel about this. ‘It’s not…it’s just…snatches of a life. A string of moments. Some chapters will be long. Others might be really short.’ (pp. 142-143)

This conversation is the only place in the book where O’Farrell describes her intentions in writing it. But, what O’Farrell describes to her mother is exactly what the book is, a memoir comprising seventeen “brushes with death,” as she calls these moments. There is no prologue, there are no interludes, there is no coda, just the seventeen stories.

Few people will experience any one of these events, and perhaps only O’Farrell has experienced all of the events she tells us about. She categorizes them based on the anatomy involved in a particular brush with death. For example, some of the chapter names are: “Lungs” (three times), “Neck” (twice), “Abdomen,” “Intestines,” “Cerebellum,” “Circulatory System,” “Whole Body.” The one exception is the chapter, “Daughter.”

Other ways of categorizing the near-death experiences O’Farrell covers could be based on whether they threatened O’Farrell herself or any of her children, whether they were the result of bad luck (e.g., illness) or bad judgment (e.g., near drowning), or whether the threat originated outside the body (e.g., accident) or within the body (e.g., illness, medical procedures). The brushes with death from outside the body involved violence (twice), decapitation (twice), drowning (three times), a plunging commercial airliner, and a knife throwing exhibition. From within her body, close calls involved encephalitis as a child, amoebic dysentery while traveling in a developing country, a Cesarean section gone awry, and a few missed miscarriages (i.e., when fetus dies but no signs or symptoms manifest and surgical procedures become necessary). A daughter was born with severe allergic conditions that caused the child misery pretty much all the time interspersed with episodes of life-threatening reactions. O’Farrell’s son was almost lost in one of her near drownings.

O’Farrell leaves it to the epigraph she placed at the beginning of the book to stitch together how these stories collectively reveal the possibility of the human spirit to get us through the most serious and persistent challenges to our being. For this epigraph, she takes a line from Sylvia Plath’s novel, The Bell Jar:

I took a deep breath and listened to the old brag of my heart. I am, I am, I am.

Esmé Weijun Wang is a novelist who has been diagnosed with
Schizoaffective Disorder. The Collected Schizophrenias is a book
of personal essays that was the 2016 winner of the Graywolf Press Nonfiction
Prize.

A precocious young person on a track to success, Wang experiences
a manic episode at Yale that leads to her first hospitalization. After a second hospitalization, her college
washes its hands of her. Hitting
roadblocks time and time again requires her to rebuild her life over and over. This is not a conventional chronological
autobiography but rather essays that provide different approaches to the
author’s experience of mental illness.
The plural “schizophrenias” of the title encompasses the whole schizophrenic
spectrum of disorders. As Wang explains,
her own diagnosis is “the fucked-up offspring of manic depression and
schizophrenia” (p. 10).

In an essay entitled “High-Functioning” we learn how the
author, having been a fashion editor, knows how to pass for normal: “My makeup
routine is minimal and consistent. I can
dress and daub when psychotic and when not psychotic. I do it with zeal when manic. If I’m depressed, I skip everything but the
lipstick. If I skip the lipstick, that
means I haven’t even made it to the bathroom mirror” (p.44).

Later, in “The Choice of Children,” volunteering at a camp
for bipolar children makes Wang think about what it would be like to inflict
her diagnosis on her own offspring. In
“Reality, On-Screen” she attempts to convey the sensation of decompensating to psychosis. And in “Yale Will Not Save You” she considers
the failure of universities to accommodate mentally ill students.

Jolted
awake by a ringing telephone, the narrator (assumed to be Mukherjee) listens to
his mother give a tearful report of his 83-year-old father’s waning health. Telling
her that he will book the next flight from New York to New Delhi, Mukherjee’s
mother wavers, regretting that her call now spurs him to purchase expensive
airfare. In a tone of knowing sarcasm, Mukherjee writes, “The frugality of her
generation had congealed into frank superstition: if I caught a flight now, I
might dare the disaster into being.” Arriving in “sweltering,
smog-choked Delhi,” Mukherjee joins his mother in a hospital’s I.C.U. A physician
himself, Mukherjee notes the facility’s piteously tumbledown conditions, its crumbling
floors and exposed utilities, jibing that, if one were to trip on the concrete
rubble, “a neurologist would be waiting conveniently for you around the corner.”
No doubt accustomed to the comfortable amenities of American hospitals, Mukherjee
magnifies the miserable disarray of the Delhi facility—a defective heartrate
monitor, a fractured suction catheter, a hospital bed with cracked wheels, a delivery
van used as an improvised ambulance. This world, far from New York, is mired in
seemingly eternal disrepair: “Delhi had landed upside down. The city was
broken. This hospital was broken. My father was broken.”

These
would seem to be the smug observations of a dismayed tourist were it not for Mukherjee’s
thoughts on the intricate and noiseless machinery of homeostasis, the cohesive
force that sustains internal constancy. “There’s a glassy transparency to
things around us that work,” he writes, “made visible only when the glass is
cracked and fissured. […] To
dwell inside a well-functioning machine is to be largely unaware of its
functioning.” As Mukherjee witnesses the spiraling decline of his father’s
health within a deteriorating, dismally ill-equipped healthcare system, he focuses
on the regularities of equilibrium by juxtaposing the homeostasis of
healthcare institutions and human bodies. Mukherjee relates a memorable story
from his early career when he staffed nightshifts at an urban clinic, where his
colleague, an older nurse, stacked oxygen masks, oiled oxygen valves, and arranged
beds. He belittled the nurse’s exacting preparations as an “obsessive absurdity”
but, when his first patient arrived with an asthma spasm, he realized how
critical the clinic’s flawless order was to his life-saving efforts: “The knob
of the oxygen turned effortlessly—who would have noticed that it had just been
oiled?—and, when I reached for an I.V. line, a butterfly needle, just the right
size and calibre, appeared exactly when I needed it so that I could keep my
eyes trained on the thin purplish vein in the crook of the elbow.” Had these
things not been prepared, had they not been finely tuned for use, had an
instrument been misplaced, would Mukherjee’s patient have lived? He experienced
an example of institutional homeostasis, conducive to optimum medical care, which
facilitated essential processes to occur successfully without mishap.

Now
in the New Delhi hospital, Mukherjee notes that its medical staff has “to
settle for a miserable equilibrium. Amid scraps and gaps and shortages, they
had managed to stabilize [my father].” He arrives at another stark realization,
“I had versed myself in the reasons that my father had ended up in the
hospital. It took me longer to ask the opposite question: What had kept my
father, for so long, from acute decline?” Recollecting his father’s life at
home in between hospitalizations, Mukherjee references a different kind of
homeostasis that helped to prolong his life. For example, when his father was unable to go to the
local market to haggle for fish and cauliflower, the vendors came to his home for usual business— “The little rituals saved him. They […]
restored his dignity, his need for constancy.” Mukherjee accentuates the protean
workings of homeostasis, its variegated forms that sustain the patterns of normalcy
that give regularity and meaning to human life—indeed, equilibrium is not only
an infinitude of minute chemical and biological factors, but familiar ease in a
world that one knows and loves. Equilibrium, however rigorously maintained,
succumbs to decay. Mukherjee aptly quotes Philip Larkin’s poem, “The Old
Fools”: “At death you break up: the bits that were you / Start speeding away
from each other for ever / With no one to see.” Mukherjee notes that the experience
of his father’s decline was not so much observing him disintegrate into a
similar kind of molecular dust, as imaged in Larkin’s verse, as it was his solidity
upheld by homeostatic forces, a steady chugging of biological gears that made intricate
compromises to sustain his deteriorating body.After
his father emerges from the coma, Mukherjee enlists curious pedestrians to help
lift him into a makeshift ambulance. His father’s jostled body resembles a
“botched Indian knockoff of an ecstatic Bernini.” The thematic kernel of
Mukherjee’s narrative, homeostasis, draws scrutiny not only to the experiences
of individual bodies but the systems and institutions that heal them, to the
material environments in which fragile bodies are cared for, repaired, and
rehabilitated. “The hospitals
that work, the ambulances that lift patients smoothly off the ground: we neglect
the small revolutions that maintain these functions,” reflects Mukherjee, “but
when things fall apart we are suddenly alert to the chasms left behind.”

This is a gripping, informative, and well-researched book
about human blood. An accomplished journalist, Rose George, covers a variety of
topics, largely in the U.S., Britain, and Canada but also in Nepal, India, and
South Africa. She describes many current
issues, provides historical background, and speculates on future technologies,
such as replacement of blood by other fluids. There are nine sections:

“My Pint” While
the book’s title refers to the author's volume of blood, this chapter’s title refers
to a single pint she is donating. We read about blood supply (donated
and stored blood) in the U.S. and—by contrast—in India.

“The Most Singular and Valuable Reptile” refers to the
leech. This arresting chapter describes both historical and modern uses of
leeches to gather blood from humans. She visits a company called Biopharm in Wales where leeches are raised and prepared for shipment to medical clinics and
hospitals.

“Janet and Percy” is a historical chapter focusing on Dame Janet Maria Vaughan, a central figure in creating the Blood
Transfusion Service in England during WWII and Percy Oliver, who guided its
predecessor, the London Blood Transfusion Service.

“Blood Borne.”
This chapter describes Khayelitsha, South Africa, “the ugly backside of
Cape Town” (p. 100): a place of poverty, crime, rape, sexual predation, and
HIV. While rich nations provide assessment and treatment for people with HIV,
poor nations have many citizens infected with the virus and, over time, rising
rates of infection.

“The Yellow Stuff” describes the plasma portion of
blood; it can be frozen (as FFP) and used as a filler for bleeding or trauma
patients. Unlike blood—which can only be
given without payment—plasma can be collected from paid donors. It is a largely
traded commodity, part of a multi-billion dollar industry worldwide. Plasma
carries Factor VIII, a crucial protein for clotting blood; hemophiliacs lack
this and are at risk for death by bleeding externally or internally. Some
plasma has been tainted, for example by HIV.

“Rotting Pickles.”
In Western Nepal (and other places), menstruation is taboo. George writes, “We are in a
minority among species, and among mammals, to bleed every month.” She reviews
historical views of women’s periods, mostly negative. Worldwide, there are many
taboos, but also some educational efforts for public health that are helpful in
impoverished areas.

“Nasty Cloths.” This tells the unusual story of an Indian
man named Muruga, “a poorly educated workshop helper” who became a leader in
creating sanitary protection for menstruating women. Worldwide, the feminine
hygiene industry is some $23 billion. George also reviews related history, including
Toxic Shock Syndrome from tampons.

“Code Red.” Bleeding is often a fatal factor in
trauma, even with the best efforts to transfuse blood into the patient, unit
after unit. George observes open chest techniques at a resuscitation. She
reviews breakthroughs in blood typing, component therapy, and “buddy
transfusions.”

“Blood like Guinness: The Future.” George starts with
images from the past: vampires, human drinkers of blood, past and, even,
present. She interviews a purveyor of the concept that “young blood” is
healthier than older blood. Can there
be, discovered or created, blood substitutes that also save lives?

Kate Walbert’s recent book, His Favorites, is a compact 149 page novella that seems to be a
direct outgrowth of the #MeToo movement, a work consciously addressed to women who
have experienced sexual abuse from those in power over
them. But linking the book to current events does an injustice to the artistry
of this exquisitely constructed work. Ms. Walbert embeds her story of sexual
exploitation in adolescence and focuses on a teenager who is abused by her popular
English teacher in a prestigious boarding school.

Jo Hadley’s story begins
abruptly. To outward appearances, she is a typical adolescent more concerned
with how she looks, having a good time, and hanging out with friends than
reading the Great Books. Suddenly, while driving a golf cart around the course
on a lazy summer night, a close friend is violently thrown over side, strikes a
tree head first, and dies instantaneously.Only later do we learn about the profound
impact this accident has had on Joy and her family.Joy is forced to transfer out of her neighborhood public school and
enroll in the Hawthorne School. But Joy is clearly talented, adapts quickly to
her new circumstances, and is placed in a special writing program for gifted
students. There she falls under the tutelage of a charismatic 34-year old
teacher, called Master. He has a reputation for running an irreverent, highly
charged classroom and is always trailed by a legion of admiring young women
from his advanced writing class.

Jo’s horrific s encounter with Master in his
residential suite is followed by a failed effort to report Master’s behavior to
the school leadership. We learn about Jo’s parents and the disintegration of
her family after the accident. We meet her schoolmates. One is an attractive
member of Master’s retinue who resurfaces several years after graduation in New
York and who still seethes with resentment at her treatment by Master. A second
classmate is musically gifted but far less stylish than the students in
Master’s English seminar. She becomes the target of a cruel hazing prank that
reverberates in Joy’s mind with the passage of time. As the book reaches its
conclusion, the context in which Joy is relating her story is unexpectedly revealed,
which casts all of her recollections in an entirely new light. The storyline is disjointed and the vantage point shifts
frequently. But the narrative is gripping and novella’s structure is
exquisitely built on apt description and poignant allusions to other works in
the literary canon including the novel A
Separate Peace by John Knowles and The
Loneliness of the Long-distance Runner by Alan Sillitoe.

In That
Jealous Demon, My Wretched Health (subtitled “Disease, Death and Composers”),
Jonathan Noble, a retired surgeon gives us the medical and psychiatric history
of seventy classical music composers. Chapters are organized by illness, ranging from cancer to syphilis to alcoholism. Famous composers such as Schubert and
Shostakovich predominate, but many lesser-known composers, ranging from
Jeremiah Clarke to Gerald Finzi, are also included.

Mozart is one composer whose cause of death
has long been the subject of controversy, and the various theories are comprehensively
explored here. However, the author goes
even further, developing a detailed medical case study of the composer
beginning in childhood. He examines the
toll that Leopold Mozart’s exploitation took on his prodigy son’s constitution,
what Wolfgang’s appearance in the surviving portraits has to say about his general
health, and even whether he may have had Tourette’s Syndrome. Finally, the author ties all of this
together, methodically refuting or confirming each diagnosis, offering far deeper
analysis than one would expect to find in a standard biography.

Another example, the case of Tchaikovsky,
reads like a veritable whodunit. The
composer’s activities during the last two months of his life are scrutinized,
with the likely causes of death systematically disproven or confirmed.

A list of composers who suffered
accidental or violent deaths provides some surprises. You will learn that Lully accidentally stabbed
himself with his conductor’s baton, and that Alkan may have been crushed to
death by a bookcase upon pulling his Talmud off a shelf.

The author, Sandeep Jauhar, attributes his “obsession” with the human heart to family history, which includes fatal heart attacks that took both of his grandfathers from him, and to the beginnings of his own coronary artery disease revealed on screening tests. That he became a practicing cardiologist, though after first becoming a PhD-level theoretical physicist, is no surprise then. It was this obsession with the heart and his chosen profession that drove him to write this book, which he says, “is about what the heart is, how it has been handled by medicine, and how we can most wisely live with—as well as by—our hearts in the future.” (p. 10) In form, the book is a series of brief accounts of selected events in the history of medicine involving the human heart and circulatory system, interwoven with personal anecdotes and reflections. Some of the historical events and developments include how the heart and circulatory system work, and the methods used to assess how well they are working such as echocardiography and coronary catheterization. How heart-lung bypass, first person to person then mechanical, made cardiac surgery possible is described, as are many of the surgical procedures it enabled to treat coronary artery disease and to replace malfunctioning valves. Nonsurgical procedures Jauhar explains encompass those for intervening during acute heart attacks (e.g., angioplasty, stents, thrombolysis), managing life-threatening heart rhythm disturbances (e.g., external and implantable pacemakers and defibrillators, radio-frequency ablation), and replacing parts or all of the heart (e.g., coronary artery bypass, heart valve replacement, left ventricular assist devices, heart transplant). Little mention is made about the use of drugs despite having contributed to both important advances and surprising failures in heart disease.

Topics related to the heart indirectly include the effects of emotions and psychological problems (e.g., stress), social determinants of disease (e.g., social economic status), and wellness concepts (e.g., diet, exercise). Some history of heart disease and the reduction of deaths from it over the past several decades are also touched upon. Parts of the book take the form of memoir, which add to his previous two books (Intern: A Doctor’s Initiation and Doctored: The Disillusionment of an American Physician).

Geoffrey
West sounds like the perfect dinner guest. He has lived a fascinating life and
his professional persona has evolved over time from theoretical physicist to
global scientist. He is a distinguished professor at the Santa Fe Institute and
is one of those rare people who knows something interesting and worthwhile about
just about everything.

In Scale, West examines networks that provide the basis for complex systems: biological systems like the human circulatory system, coastal ecosystems, and man-made systems like urban communities and global corporations. He identifies three defining features shared by each. First, the networks serve the entire system and fill the entire space that is available. Second the terminal units in the networks share common design features and are essentially the same, whether they are the capillaries that provide nutrients and oxygen to peripheral tissues or the electrical outlets that enable access to the grid for home appliances.First, the networks serve the entire system and fill the entire space that is
available. Second the terminal units in the networks share
common design features and are essentially the same, whether they are the
capillaries that provide nutrients and oxygen to peripheral tissues or the
electrical outlets that enable access to the grid for home appliances. Finally,
there is a natural selection process at work that is constantly optimizing the
network function. West emphasizes that these defining features of complex
systems are present in biological systems like the human circulatory system,
coastal ecosystems, and man-made systems like urban communities and global
corporations.
These common features enable West to
identify fairly simple mathematical formulas that predict the relationship
between changes in size and efficiency of complex systems. In general, in
biological systems size and energy consumption are scaled sublinearly, i.e.,
metabolic rate does not increase to the same extent as size. The limits to
growth occur because of the increased demands for maintenance of the system.
What makes Scale an innovative work
is West’s effort to apply the scaling laws derived from observations in nature to
man-made complex systems such as cities and companies. He identifies two
distinct components in these human systems, the materials that constitute the
infrastructure and the creative work that is produced. West then demonstrates
that while the physical demands of these complex human systems, such as roads,
electricity, and water supply, which mirror the metabolic requirements of
biological systems, increase
sublinearly, the productive output like
wages, theaters, and patent activity, which have no parallel in non-human
biological systems, increase supralinearly. Moreover, this inventive works requires
a proportionately increasing input of resources as size increases. West tries
to draw lessons about the rational limits to growth by extrapolating from the
scaling laws that underlie biological complex systems to the two components of
the artificial systems created by mankind. West cautions against blind reliance
on “big data” alone to solve the pressing social problems confronting mankind.
Instead, he advocates for delineation of underlying mathematical principles to
guide the analysis of the growth of cities and companies and rational future
planning.

In 2006, Emergency medicine trainee, Damon, and his wife, Trisha, have two boys, Thai (age 4) and Callum (age 2.5). All is well in their lives until Callum begins vomiting for no apparent reason. He is found to have medulloblastoma, an aggressive brain tumour, for which the only possible hope for a cure comes from surgery and six cycles of ever more arduous chemotherapy with stem cell recovery at Toronto’s Hospital for Sick Children. The little family moves to Toronto and commits to supporting Callum as best they can, ensuring that he is never alone even during his long weeks of reverse isolation. They also try to keep Thai nearby, involved and aware, with the help of a local school and grandparents. But Callum dies during the last cycle of treatment. Saddened, exhausted, and bereaved, Damon and Trisha go back to their home town and try to (re)construct their lives, slowly returning to studies and work. They find meaning in creating tangible and intangible memorials to their lost son, and they find purpose in the more difficult task of moving forward, never losing the pain of grief. They adopt a little girl. Damon knows that Callum is always with him and the experience of his illness and death has dramatically infused his work as a physician.